A Case Report On Multicentric Castleman’s Disease (Mcd) And Co-Morbidities At Muhimbili National Hospital, Dar Es Salaam, Tanzania
Keywords:
Castleman’s disease, MCD, HHV-8, HIV, lymphoproliferative disorderAbstract
Background: Castleman’s disease (CD) is a rare pre-cancerous lymphoproliferative disorder comprising at least four poorly understood and heterogeneous hematological disorders/variants sharing a spectrum of common characteristic histopathological features.
Case Summary: Here we report a case of Multicentric Castleman’s disease (MCD) seen in a 55- year old male who presented with fever, frequent urination, thirst, multiple neck swellings as well as night sweats. Furthermore, the patient had history of diabetes mellitus (DM) and systemic hypertension (SH). Imaging revealed splenomegaly. The patient underwent further confirmatory laboratory tests and the diagnosis of MCD was entertained. Furthermore, the patient was given chemotherapy (CHOP and rituximab) and also opted for surgery; unfortunately however, the patient died during the procedure.
Discussion: There are at least four clinicopathological forms of Castleman’s disease namely, Unicentric (UCD), Multicentric (MCD), idiopathic (iMCD) as well as HHV8 associated-MCD. (1) Our current patient was diagnosed with MCD [which can be Human Herpesvirus type 8 (HHV-8)-associated], and then underwent different therapeutic interventions. Unfortunately, the patient died under physician care partly, due to co-morbidities (DM and SHT) besides the underlying disease (MCD) itself, possibly contributed by delayed presentation to hospital as well as limited experience in caring a rather rare condition in our settings.
Conclusion and recommendation: MCD is rare but occurs at MNH and may associated with delayed presentation and/or a missed diagnosis. We recommend regular check-ups and self–examination for any enlarged lymph nodes, and when CD is diagnosed, early interventions including screening for HHV-8 and HIV infections as well as treatment may be helpful. Co-morbidities must also be considered when planning surgical interventions in order to get the best treatment outcome.
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